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U.S. surgeon explores the Feminization of the Transsexual

by Douglas K. Ousterhout, M.D., D.D.S.

Looking feminine is, of course, extremely important to you. First impressions are often based just upon your face. That which is first seen in an initial contact is frequently what defines you. It establishes not only who you are, but often what sex you are as well. As a transsexual, perhaps nothing is more important to you than appearing sexually the same as you feel emotionally. Facial feminizing surgery can help bring these two together.

Cosmetic (aesthetic surgery) of the face can be directed toward many aspects of facial appearance. The majority of facial aesthetic surgery in this country is to reduce the effects of aging - reducing wrinkles, lifting sagging skin, or removing fat deposits. Facelifts, brow (forehead) lifts, blepharoplasties (cosmetic surgery of the eyelids), and removing excess fat in the neck are among the most frequently completed aesthetic facial soft tissue procedures that I do. A great deal of my aesthetic surgery, though, is directed toward changing facial contours by modifying the basic bony supporting configuration of the face.

Surgery such as a rhinoplasty (nasal surgery), chin, cheek and forehead modifications (either reduction or augmentation), changing the shape of the mandibular angle, and - in certain patients - moving the upper and/or lower jaws are frequently completed by me as well.

I have edited the only medical book describing all of these different types of bony surgery that can be completed on the face. This book, titled Aesthetic Contouring of the Craniofacial Skeleton (Little, Brown and Company), also discusses another important aspect of facial contouring - Feminization of the Face.

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There are basic differences between a male and a female skull -- differences long appreciated not only by anthropologists studying skulls, but by artists as well. Females have a more pointed chin and less nasal prominence than males. The forehead is quite different, especially the areas of the brows and the mid forehead. The shape of the skull affects the drape and contour of the skin. Changing the shape of the skull will assist in changing one from distinctly male to female. Modifying the angle of the lower jaw and the prominence of the cheeks can also help improve femininity.

The techniques used and the areas modified are individualized. Quite obviously some transsexuals are already much more feminine than others. What is completed is based upon a combination of skeletal and artistic evaluations, radiographs (x-rays), anthropological measurements, asymmetry gauges, facial masks and photographs. Patient self assessment is also very important to surgical planning. Based on all of the above, a treatment program is established.

About the writer:

I started my college education at the University of Colorado, Boulder. Next I went to the Minerva Institute in Zurich, Switzerland. I then attended the University of Michigan in Ann Arbor, where I received my dental degree in 1961, and my medical degree in 1965. While there, I was inducted into several honour societies, including Dental Academic, Medical Historical, and Medical Academic Honour Fraternities.

I continued at the University of Michigan as a resident in general surgery after serving as a Captain in the U.S. Army Medical Corps from 1966-1968, and completed my residency in Plastic Surgery at Stanford University Medical Center, where I held the position of Chief Resident from 1971-1972. From there I traveled to Paris to become the first American to assist Doctor Paul Tessier in the techniques of craniofacial surgery.

Upon my return to the United States, I was certified by the American Board of Plastic Surgery in 1974, and have been in the practice of plastic surgery in San Francisco since then. I have fellowships with 185 medical societies including American Society of Plastic and Reconstructive Surgeons, American Society for Aesthetic Plastic Surgery, International Society of Aesthetic Plastic Surgery, Societe Francaise de Chirurgie Plastique Reconstructrice et Esthetique, American Society of Maxillofacial Surgeons, The Harry S. Benjamin International Gender Dysphoria Association, and the International Society of Craniofacial Surgery.

I am, and have been, on the boards of many plastic surgical societies, including being President of the American Society of Maxillofacial Surgeons (1994-1995), and on the editorial board of four different plastic surgery journals. I am on the Advisory Committee for "Recommended Guidelines for Transgender Care", AEGIS.

I hold staff memberships at several hospitals, including Davies Medical Center, Saint Francis Memorial Hospital, California Pacific Medical Center, and the University of California, San Francisco, where I am a Clinical Professor of Plastic Surgery, participating especially with a panel of experts at the Center for Craniofacial Anomalies. I have operated in many countries outside the United States.

Throughout my career, I have presented dozens of major scientific papers, both nationally and internationally. I have published scores of scientific papers. My medical textbook, Aesthetic Contouring of the Craniofacial Skeleton, was published in 1991.

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